Dr. Sandra Mendlowitz, C. Psych Psychologist, Anxiety Disorders Team, Department of Psychiatry The Hospital for Sick Children Assistant Professor, Dept. of Child Psychiatry, Faculty of Medicine, University of Toronto
Common
emotional state
Intertwined
with concepts such as stress and uncertainty
Function
is to signal danger
© 2008 S. Mendlowitz, PhD.C.Psych.
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Pathological
anxiety as distinguished from ‘normal’ anxiety (common state)
Definition
is that the anxiety is interfering in one’s day to day functioning
Differentiated
from fears that are developmentally appropriate
© 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
Pathological
anxiety as distinguished from ‘normal’ anxiety (common state)
Definition
is that the anxiety is interfering in one’s day to day functioning
Differentiated
from fears that are developmentally appropriate
© 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
“Is the child functioning at their age-appropriate level?” Infant/Toddlers - separation, novel Preschool - animals, dark, separation Latency-age - adaptations, performance, family Pre-Adolescence -mortality, health Adolescence- social, existence, future © 2008 S. Mendlowitz, PhD.C.Psych.
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Most common in childhood: Generalized Anxiety Disorder Obsessive Compulsive Disorder Specific Phobias (Separation Anxiety Disorder)
Most common in adolescence: Panic Disorder w/o agoraphobia Social Anxiety Disorder Post Traumatic Stress Disorder
© 2008 S. Mendlowitz, PhD.C.Psych.
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High prevalence in non-referred children
Most common mental health problem
10% of children and adolescents
6-18% ages 6 to 17 years old
often unrecognized, undiagnosed, untreated
© 2008 S. Mendlowitz, PhD.C.Psych.
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1.
Number & types of fears across cultures fairly consistent
2.
Presence of one anxiety disorder increases risk of developing additional anxiety disorder
3.
Children & youth with anxiety disorders rarely receive appropriate or effective interventions © 2008 S. Mendlowitz, PhD.C.Psych.
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Angry outbursts Temper tantrums Aggression Attention seeking behaviors Oppositional and refusal behaviors Hyperactivity and difficulty sitting still Attention and concentration problems; difficulty learning
Academic underachievement or excessive resistance to doing work Not completing school work Frequent visits to school nurse or physician (especially for physical complaints)
High number of missed school days Difficulties with social or group activities
© 2008 S. Mendlowitz, PhD.C.Psych.
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1. Genetics/temperament 2. Mother-child attachment pattern 3. Parental psychopathology 4. Parenting style 5. Brain chemistry © 2008 S. Mendlowitz, PhD.C.Psych.
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Thomas
and Chess
(Longitudinal Study in NY: 85 middle-class families with 133 children)
3 recognized clusters:
Easy child (positive mood, adaptable; positive to novelty) Difficult child (irritable, intense) Slow-to-warm-up (negative response to novelty; mild intensity; gradual adaptation after repeated contact)
© 2008 S. Mendlowitz, PhD.C.Psych.
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Behavioral inhibition in young children
Characterized as persistent, fearful, avoidant behavior in response to new situations and novel stimuli
Toddlers: Irritable, shy, fearful
Latency age: cautious, quiet, introverted
Increases likelihood of later developing anxiety disorders (esp. social phobia in adolescence) © 2008 S. Mendlowitz, PhD.C.Psych.
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Attachment
enduring emotional bond uniting one person with another manifested in efforts to seek proximity + contact to attachment figure important psychological catalyst for early emergence of trust in others + self understanding bonding involves active, reciprocal interactions between infant and caregivers
Insecure mother-child attachment pattern linked to subsequent onset of anxiety
© 2008 S. Mendlowitz, PhD.C.Psych.
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History of anxiety & depression Controlling, overprotective parenting style ?conditioning of symptoms? Well-intended responses
(e.g., overprotecting, reassuring, avoiding, perfectionist standards)
7 times more likely to have children with an anxiety disorder © 2008 S. Mendlowitz, PhD.C.Psych.
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Wolfradt ,Hempel, Miles (2003) perceived parental psychological pressure correlated positively with depersonalisation and trait anxiety among the adolescents parental warmth was positively associated with active coping & negatively correlated with trait anxiety in the adolescents
McGinn, Cukor, & Sanderson (2005)
individuals who rate their parents as being more abusive & neglectful reported a greater degree of depression & dysfunctional cognitive style
Liebowitz (2007) "overprotectiveness brings out the worst in kids." high proportion of panic patients had overprotective parents
Kagan & Arcus (2007)
"Parents' actions affect the probability of anxiety disorder in the child“ © 2008 S. Mendlowitz, PhD.C.Psych.
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Evidence for neurobiological involvement such as hormonal abnormalities (CCK) and neurotransmitters (serotonin)
© 2008 S. Mendlowitz, PhD.C.Psych.
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Avoidance Withdrawal Escape
from the situation
Distraction Seek
much Reassurance
Resist
CARE Comply Accommodate Reassure Enable
change
ANXIOUS CHILDREN
ANXIOUS PARENTS © 2008 S. Mendlowitz, PhD.C.Psych.
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Avoidance Withdrawal Escape
from the situation
Distraction Seek
much Reassurance
Resist
CARE Comply Accommodate Reassure Enable
change
ANXIOUS CHILDREN
ANXIOUS PARENTS © 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
Evidence-based
treatments
Shown to work in well-controlled scientific studies in which treatment effectiveness is systematically evaluated
Medication Cognitive-Behavioral
Therapy (CBT)
Both associated with improvements
Can be used alone or in combination
CBT
superior in long-term & usually first line recommended treatment © 2008 S. Mendlowitz, PhD.C.Psych.
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VULNERABILITY HYPER ALERT Global Scanning Behavioral Inhibition (silence, avoidance)
Perceptual Distortion
Focused Attention (internal feelings)
Interpretation Probable Harm ANXIETY ESCAPE
AVOID
BLOCK
COPE
© 2005 S. Mendlowitz, C.Psych.
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© 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
1.
Homework reviewed
2.
New material (lesson) presented
3.
Practice concept
4.
Modeling desired behaviors for the child
5.
Verbal praise & tangential rewards for effort and approximations to desired behavior
6.
Suggestions given regarding monitoring or challenging self © 2008 S. Mendlowitz, PhD.C.Psych.
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Parental Set
/ family involvement critical
limits with the family
Clarify
roles of people
Establishes
the family
roles & clear communication in
Identify
any parental psychopathology requires treatment & suggest referral
© 2008 S. Mendlowitz, PhD.C.Psych.
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Critical
- research evidence (Mendlowitz, Manassis, et al
1999. Barret et al, 2007)
They |
may be modeling anxious behaviors!
corrective feedback
Teach
proper reward systems
Behavior Coach
management (e.g., 1-2-3 Magic by T. Phelan)
– reinforce learned strategies
Help
child with anxious situations involving the home environment © 2008 S. Mendlowitz, PhD.C.Psych.
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Families serve important roles in a child’s anxiety:
What is the role of the family?
Who can help to reinforce good coping?
Are all members supportive?
Marital or other family conflict?
Family history of anxiety/depression?
© 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
Photo removed
© 2008 S. Mendlowitz, PhD.C.Psych.
No unauthorized reproduction
